支气管肺发育不良极早产儿宫外生长迟缓影响因素分析  

Risk factors of extrauterine growth retardation in very preterm infants with bronchopulmonary dysplasia

作　　者：王雅森 沈蔚 唐丽霞[1] 杨庆[1] 林新祝 Wang Yasen;Shen Wei;Tang Lixia;Yang Qing;Lin Xinzhu(Department of Neonatology,Women and Children's Hospital,School of Medicine,Xiamen University,Xiamen Key Laboratory of Perinatal-neonatal Infection,Xiamen 361003,China)

机构地区：[1]厦门大学附属妇女儿童医院(厦门市妇幼保健院)新生儿科,厦门市围产-新生儿感染重点实验室,厦门361003

出　　处：《中华新生儿科杂志（中英文）》2022年第3期208-213,共6页Chinese Journal of Neonatology

基　　金：2019年厦门市医疗卫生指导性项目(3502Z20199139);2021年厦门市医疗卫生指导性项目(3502Z20214ZD1225)。

摘　　要：目的分析支气管肺发育不良(bronchopulmonary dysplasia,BPD)极早产儿的医院内营养状况及发生宫外生长迟缓(extrauterine growth retardation,EUGR)的影响因素。方法采用回顾性队列研究方法,收集厦门市妇幼保健院新生儿重症监护室2017年1月至2020年6月收治的BPD极早产儿临床资料,将纳入患儿分为EUGR组和非EUGR组,分析其营养状况及发生EUGR的影响因素。结果共纳入BPD极早产儿225例,EUGR组143例(63.6%),非EUGR组82例(36.4%)。EUGR组出生体重低于非EUGR组(P<0.001),两组胎龄比较差异无统计学意义(P=0.733)。轻、中、重度BPD极早产儿EUGR发生率差异有统计学意义(41.9%比70.8%比90.7%,P<0.001)。与非EUGR组相比,EUGR组产前足疗程激素使用率较低(47.6%比63.4%,P=0.022),肠外营养时间、禁食时间、达全肠内喂养时间较长(P<0.05),加奶速度、体重增长速率较慢,喂养不耐受发生率较高(P<0.05)。多因素Logistic回归分析结果显示中重度BPD、出生体重<1000 g、喂养不耐受是BPD极早产儿发生EUGR的独立危险因素,出生时使用肺表面活性物质对BPD极早产儿发生EUGR具有预测作用;体重增长速率>13 g/(kg·d)、产前足疗程使用激素是EUGR的保护因素。结论应提高极早产儿产前足疗程激素使用率,出生时谨慎使用肺表面活性物质;同时,重视BPD极早产儿肠内营养管理,提高体重增长速率,对降低BPD极早产儿EUGR的发生率具有重要作用。Objective To study the nutritional status of very preterm infants(VPIs)with bronchopulmonary dysplasia(BPD)during hospitalization and the risk factors of extrauterine growth retardation(EUGR).Methods From January 2017 to June 2020,clinical data of VPIs with BPD hospitalized in the department of neonatology of our hospital were retrospectively studied.The infants were assigned into EUGR group and non-EUGR group and their nutritional status and the risk factors of EUGR were compared.Results A total of 225 VPIs were enrolled,including 143 cases of EUGR(63.6%)and 82 non-EUGR(36.4%).The EUGR group had significantly lower birth weight(BW)than non-EUGR group(P<0.001).No significant difference existed in the gestational age(GA)between the two groups(P=0.733).The incidences of EUGR in VPIs with mild,moderate and severe BPD were 41.9%,70.8%and 90.7%,respectively and the differences were statistically significant(P<0.001).Compared with non-EUGR group,EUGR group received less full-course antenatal corticosteroids(47.6%vs.63.4%,P=0.022).EUGR group had longer duration of parenteral nutrition,fasting time and achieving full enteral nutrition(P<0.05).EUGR group also showed slower increment of enteral feed volumes,slower growth velocity and higher incidence of feeding intolerance(P<0.05).Multivariate logistic regression analysis showed that moderate/severe BPD,BW<1000 g and feeding intolerance were independent risk factors for EUGR in VPIs.The use of pulmonary surfactant at birth was a predictive factor for EUGR in VPIs with BPD.Growth velocity>13 g/(kg·d)and full-course of antenatal corticosteroids were protective factors of EUGR for BPD infants.Conclusions It is necessary to improve the use of full-course antenatal corticosteroids to reduce the application of pulmonary surfactant at birth in VPIs.Better enteral nutrition and improved growth velocity will help reducing the incidence of EUGR in VPIs with BPD.

关 键 词：支气管肺发育不良 宫外生长迟缓 极早产儿 营养 危险因素 

分 类 号：R722.6[医药卫生—儿科]